Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the US Military HIV Natural History Study
Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the US Military HIV Natural History Study
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DOI：
10.1186/1742-6405-7-14
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发表时间：
2010-01-01
影响因子：
2.2
通讯作者：
Agan, Brian K.
中科院分区：
文献类型：
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作者：
Marconi, Vincent C.;Grandits, Greg A.;Agan, Brian K.
背景资料：为探讨高效抗逆转录病毒治疗（HAART）对免费医疗人群的疗效，我们对1996年至2007年底接受HAART治疗的2327例HIV感染军人和受益者进行了队列研究。方法：分析结果包括病毒学抑制（VS）和失败（VF）、CD4计数变化、艾滋病和死亡。VF被定义为从未抑制或至少有一个反弹事件。多变量（MV）分析分层的HAART启动年（2000年之前或之后），以确定与这些outcome.Results相关的危险因素：在2000年后开始HAART的患者中，81%的VS在1年（N = 1，759），85%在5年（N = 1，061），82%在8年（N = 735）。HAART后5年，中位CD4增加为247个细胞/ml，34%发生VF。5年的艾滋病和死亡率分别为2%和0.3%。在根据与治疗反应相关的已知风险因素调整的MV模型中，（与退休相比）在HAART启动时与艾滋病风险降低相关（HR = 0.6，95% CI 0.4 - 1.0）和死亡率（0.6，0.3 - 0.9），增加的概率CD4增加= 50%（1.2，1.0 - 1.4），但并不显着VF.Conclusions：在这个观察队列，VS率接近临床试验中描述的。在现役中启动HAART与更好的结果相关。这些研究结果支持免费获得医疗保健可能改善HAART反应，从而降低艾滋病毒相关的发病率和死亡率的概念。
Background: To examine the outcomes of highly-active antiretroviral therapy (HAART) for individuals with free access to healthcare, we evaluated 2327 patients in a cohort study composed of military personnel and beneficiaries with HIV infection who initiated HAART from 1996 to the end of 2007.Methods: Outcomes analyzed were virologic suppression (VS) and failure (VF), CD4 count changes, AIDS and death. VF was defined as never suppressing or having at least one rebound event. Multivariate (MV) analyses stratified by the HAART initiation year (before or after 2000) were performed to identify risk factors associated with these outcomes.Results: Among patients who started HAART after 2000, 81% had VS at 1 year (N = 1,759), 85% at 5 years (N = 1,061), and 82% at 8 years (N = 735). Five years post-HAART, the median CD4 increase was 247 cells/ml and 34% experienced VF. AIDS and mortality rates at 5 years were 2% and 0.3%, respectively. In a MV model adjusted for known risk factors associated with treatment response, being on active duty (versus retired) at HAART initiation was associated with a decreased risk of AIDS (HR = 0.6, 95% CI 0.4-1.0) and mortality (0.6, 0.3-0.9), an increased probability of CD4 increase = 50% (1.2, 1.0-1.4), but was not significant for VF.Conclusions: In this observational cohort, VS rates approach those described in clinical trials. Initiating HAART on active duty was associated with even better outcomes. These findings support the notion that free access to healthcare likely improves the response to HAART thereby reducing HIV-related morbidity and mortality.